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Hakimi T. Congenital megalourethra. Ann Med Surg (Lond) 2022; 84:104926. [PMID: 36582879 PMCID: PMC9793179 DOI: 10.1016/j.amsu.2022.104926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Congenital megalourethra is a urogenital anomaly characterized by a cystic dilatation and elongation of the penile urethra resulting from the absence and hypoplasia of the corpus spongiosum and corpus cavernosum, or anterior urethral valve. There are two clinical types: scaphoid and fusiform. Generally, the etiology is unknown, but it is thought to be a defect in mesodermal development. Fewer than 100 cases have been reported in the literature, and the exact incidence is unclear. In most cases, the surgical procedure is challenging and requires extensive reconstructive and/or replacement surgery. Case presentation We present a 6-month-old boy suffering from a cystic dilatation of the penile urethra along with urine dribbling during micturition since birth. The patient was diagnosed with the scaphoid type of megalourethra and was operated on using reduction urethroplasty. On the 21st post-operative day, we removed the Foley catheter and followed the patient on two occasions (the 45th post-operative day and the 6th post-operative month) with excellent results. Conclusion The anagement of megalourethra depends on the clinical type. Meticulous surgical technique, the use of fine suture materials with careful handling, and fixation of the vascularized flap are the main principles of an acceptable result. Observation of erectile function and fertility require long-term follow-up.
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Ibrahimli A, Huseynli K, Galandarova A, Samadov E, Jafarova A. Spontaneously Resolved Penile Cyst in a Fetus: A Case Report and Review of the Literature. Cureus 2022; 14:e28110. [PMID: 36127997 PMCID: PMC9480858 DOI: 10.7759/cureus.28110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/05/2022] Open
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Cruz-Martínez R, Martínez-Rodríguez M, Gámez-Varela A, Luna-García J, López-Briones H, Chávez-González E, Villalobos-Gómez R, Juárez-Martínez I. Fetoscopic urethral meatotomy in fetuses with lower urinary tract obstruction by congenital megalourethra. Prenat Diagn 2021; 41:772-777. [PMID: 33792084 DOI: 10.1002/pd.5946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND To describe the perinatal outcomes of fetoscopic urethral meatotomy (FUM) in fetuses with lower urinary tract obstruction (LUTO) by congenital megalourethra. STUDY DESIGN Between 2012 and 2020, 226 cases with LUTO were referred to our fetal surgery center in Queretaro, Mexico. We report the perinatal outcome of cases with LUTO by congenital megalourethra that were selected for FUM in an attempt to release the penile urethral obstruction. RESULTS Congenital megalourethra was diagnosed in 10 cases (4.4%) but only 3 cases (30%) with obstructive megalourethra and megacystis were selected for fetal surgery. Fetoscopic urethral metatotomy was successfully performed in all three cases at a median gestational age (GA) of 21.4 (18.0-26.7) weeks and with a median surgical time of 27 (12-43) min. A resolution of urethral dilatation and subsequent reduction of the penile length and normalization of both the bladder size and amniotic fluid were observed in all cases. The median GA at delivery was 35.2 (range: 30.6-38.0) weeks. There were no fetal deaths but one neonatal death (33%) secondary to renal failure and preterm delivery. CONCLUSION In fetuses with LUTO by congenital obstructive megalourethra, FUM is feasible and is associated with good perinatal outcomes.
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Affiliation(s)
- Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
- Instituto de Ciencias de la Salud (ICSa), Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, México
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, México
| | - Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Erendira Chávez-González
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
| | - Israel Juárez-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Queretaro, México
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Anh DD, Nguyen HT, Meagher S, Araujo Júnior E. Prenatal diagnosis of congenital megalourethra in the second trimester of pregnancy. J Ultrason 2019; 19:302-304. [PMID: 32021712 PMCID: PMC6988452 DOI: 10.15557/jou.2019.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/29/2019] [Indexed: 11/22/2022] Open
Abstract
Congenital megalourethra is abnormal dilation of the penile urethra due to aplasia of erectile tissue, leading to lower urinary tract obstruction. This condition should be considered when fetal penis with typical dilation is seen on prenatal scan. The dilated structure, however, can be easily missed or misinterpreted as the umbilical cord. Perinatal prognosis is poor due to direct consequences on urinary and respiratory systems, or due to severe associated anomalies. A large number of survived cases experience urinary sequelae and renal impairment. We report one case of fetal congenital megalourethra diagnosed at 17 weeks and 6 days of pregnancy.
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Affiliation(s)
- Do Duy Anh
- Pham Ngoc Thach University, Ho Chi Minh City, Vietnam
| | - Ha To Nguyen
- Imaging Diagnostic Department, Tudu maternity Hospital, Ho Chi Minh City, Vietnam
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Perlman S, Borovitz Y, Ben-Meir D, Hazan Y, Nagar R, Bardin R, Brusilov M, Dekel B, Achiron R, Gilboa Y. Prenatal diagnosis and postnatal outcome of anterior urethral anomalies. Prenat Diagn 2019; 40:191-196. [PMID: 31654578 DOI: 10.1002/pd.5582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/24/2019] [Accepted: 09/15/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Anterior urethral anomalies (AUA) which present as anterior urethral valve, stenosis or atresia, are a rare cause for congenital urinary tract obstruction. We present our AUA prenatal diagnosis case series. METHODS Fetuses presenting with prenatal findings suggestive for AUA according to postnatal reported clinical and imaging signs (urinary tract dilatation, dilated bladder, enlarged edematous fetal penis, dilatation of the fetal urethra and diverticula) were followed prospectively. RESULTS Six fetuses were diagnosed with AUA. Diagnosis was confirmed upon examination of the neonate or the abortus. All cases presented with variable degrees of urinary tract dilatation. Four fetuses who presented with additional congenital anomalies of the kidneys and urinary tract (CAKUT) developed intra-uterine or early postnatal renal failure, while two isolated AUA cases have a normal renal outcome. CONCLUSIONS AUA is a rare diagnosis. However, high index of suspicion and careful sonographic assessment of the male fetal urethra in cases referred for urinary tract dilatation may enable appropriate parent counseling, optimal prenatal surveillance and timed postnatal urological intervention. As in other lower urinary tract obstructions, future renal function seems to correlate with associated CAKUT, therefore close follow up throughout pregnancy and meticulous sonographic assessment is recommended.
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Affiliation(s)
- Sharon Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Borovitz
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Schneider Children's Medical Center, Nephrology Institute, Petach Tikva, Israel
| | - David Ben-Meir
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pediatric Urology Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Yenon Hazan
- Ultrasound Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel.,Hadassah and the Hebrew University Medical School, Jerusalem, Israel
| | - Ran Nagar
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Bardin
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Ultrasound Unit, The Helen Schneider Women's Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Michael Brusilov
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Ultrasound Unit, Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Benjamin Dekel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Division of Pediatric Nephrology, Edmond and Lily Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Pediatric Stem Cell Research Institute, Edmond and Lily Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yinon Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Chao AS, Chang YL, Hsieh PCC. Prenatal diagnosis of congenital megalourethra with imperforate anus. BMC Pediatr 2019; 19:123. [PMID: 31014306 PMCID: PMC6477713 DOI: 10.1186/s12887-019-1510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 04/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background Congenital megalourethra is a rare prenatal finding while prenatal diagnosis of imperforate anus poses high challenge. This is the first prenatally ultrasound diagnosed case which had congenital megalourethra and imperforate anus. This case demonstrated the possibility of using the prenatal imaging findings to evaluate the postnatal prognostic outcomes in multi-organ anomalies. Case We present a case of congenital megalourethra, diagnosed prenatally at 22 weeks’ gestation, in which the penis appeared severe dilated with complete absence of the corpora spongiosa and cavernosa. This case also revealed absence of perianal muscle which was in associated with imperforate anus. Detailed prenatal ultrasonographic findings predicted the high possibility of poor outcome of the fetus in the pulmonary, renal, and sexual functions. Conclusion This case serves to identify not only the marked bilateral hydronephrosis features but also the striking lower urethral malformation with obstruction flow effect of the penis. Indeed we believe this is the first case report of a rare case of fetal megalourethra associated with imperforate anus at early second trimester on ultrasonography imaging.
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Affiliation(s)
- An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, LinKou, Republic of China. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu Shin street, Kwei Shan, Tao Yuan, 333, Taiwan.
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, LinKou, Republic of China
| | - Peter Ching-Chang Hsieh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Republic of China
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Long-term renal outcome in infants with congenital lower urinary tract obstruction. Prog Urol 2018; 28:596-602. [PMID: 29980359 DOI: 10.1016/j.purol.2018.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/30/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Congenital Lower Urinary Tract Obstructions (LUTO) is a heterogeneous group of diseases in which urine elimination is obstructed at the level of bladder neck or urethra. The aim of the study is to evaluate the long-term renal outcome of patients suffering of congenital LUTO. PATIENTS AND METHOD We retrospectively reviewed patients with congenital LUTO. All patients had at least 1 year follow-up. Data on surgery, renal imaging and Schwartz estimate creatinine clearance were collected. Incidence of Chronic Renal Disease (CRD) is presented with Kaplan-Meier method. RESULTS 40 patients were included, 23 patients with Posterior Urethral Valve (PUVs) and 17 patients with other aetiologies: anterior urethral valve (2), urethral atresia (2), urethral stenosis (2), cloacal malformations (2), obstructive ureterocele (1), bladder trigone malformation (1) and neonatal bladder-sphincter dysfunction without neurological abnormalities (7). Incidence of CRD at age 10 years was 37% in congenital LUTO, 42% in PUVs and 30% in other aetiologies, and was significantly higher in PUVs (P=0.032). Renal prognosis was significantly worsened by discover of retentional bladder wall changes in initial cystoscopy, and by loss of parenchymal differentiation or cortical microcysts in first ultrasonography. The use of urinary diversion was significantly higher in LUTO of other aetiologies. CONCLUSION A high incidence of CRD is observed in patients with congenital LUTO, significantly higher in patients with PUV. LUTO of other aetiologies require step by step surgical management and higher use of urinary diversion. Precise initial evaluation in cystoscopy and ultrasonography is required and participate to evaluate future renal outcome. LEVEL OF INCIDENCE 4.
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Macedo A, Ottoni SL, Parizi JLG, Martins GMC, Garrone G, Cruz MLD. Megalourethra and urethrorectal fistula: a rare presentation and a challenging reconstruction. Int Braz J Urol 2017; 43:172-173. [PMID: 28124546 PMCID: PMC5293404 DOI: 10.1590/s1677-5538.ibju.2015.0676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/05/2016] [Indexed: 11/21/2022] Open
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Laseca Modrego M, Garcia Rodriguez R, Armas Roca M, Garcia Delgado R, Romero Requejo A, Medina Castellano M, Garcia Hernandez JA. Prenatal diagnosis of foetal labial fusion. J OBSTET GYNAECOL 2016; 37:243-245. [PMID: 27922273 DOI: 10.1080/01443615.2016.1244807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maria Laseca Modrego
- a Prenatal Diagnosis and Fetal Therapy Unit. Department of Obstetrics and Gynecology , University Maternity Hospital of Canary Island , Gran Canaria , Las Palmas , Spain
| | - Raquel Garcia Rodriguez
- a Prenatal Diagnosis and Fetal Therapy Unit. Department of Obstetrics and Gynecology , University Maternity Hospital of Canary Island , Gran Canaria , Las Palmas , Spain
| | - Marta Armas Roca
- a Prenatal Diagnosis and Fetal Therapy Unit. Department of Obstetrics and Gynecology , University Maternity Hospital of Canary Island , Gran Canaria , Las Palmas , Spain
| | - Raquel Garcia Delgado
- a Prenatal Diagnosis and Fetal Therapy Unit. Department of Obstetrics and Gynecology , University Maternity Hospital of Canary Island , Gran Canaria , Las Palmas , Spain
| | - Azahar Romero Requejo
- a Prenatal Diagnosis and Fetal Therapy Unit. Department of Obstetrics and Gynecology , University Maternity Hospital of Canary Island , Gran Canaria , Las Palmas , Spain
| | - Margarita Medina Castellano
- a Prenatal Diagnosis and Fetal Therapy Unit. Department of Obstetrics and Gynecology , University Maternity Hospital of Canary Island , Gran Canaria , Las Palmas , Spain
| | - Jose Angel Garcia Hernandez
- a Prenatal Diagnosis and Fetal Therapy Unit. Department of Obstetrics and Gynecology , University Maternity Hospital of Canary Island , Gran Canaria , Las Palmas , Spain
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Quibel S, Brasseur-Daudruy M, Liard-Zmuda A, Gaillard P, Verspyck E. Posterior urethral valves: how the study of fetal micturition can help to reach the diagnosis? Prenat Diagn 2016; 36:794-5. [PMID: 27351949 DOI: 10.1002/pd.4865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/17/2016] [Accepted: 06/11/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Solene Quibel
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | | | - Agnes Liard-Zmuda
- Department of Pediatric Surgery, Rouen University Hospital, Rouen, France
| | - Pascale Gaillard
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
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Cheng SY, Chen SJ, Lai HS. Congenital anterior urethrocutaneous fistula at the penoscrotal junction with proximal penile megalourethra: A case report. J Radiol Case Rep 2016; 10:33-7. [PMID: 27200160 DOI: 10.3941/jrcr.v10i2.2533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Congenital anterior urethrocutaneous fistula and megalourethra are both rare anomalies. These anomalies are commonly associated with other anorectal or genitourinary anomalies and evaluated with voiding cystourethrography. We examined a 34-month-old boy who presented with a fistula at the penoscrotal junction. A voiding cystourethrogram showed a jet of urine coming through the fistula and proximal saccular dilatation of the penile urethra. We present the imaging findings of the first case of an association between a congenital anterior urethrocutaneous fistula at the penoscrotal junction and a proximal penile megalourethra. We also discuss the etiology, management, and differential diagnosis of this entity, and review the literature.
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Affiliation(s)
- Shih-Yao Cheng
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Shyh-Jye Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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12
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Moaddab A, Sananes N, Hernandez-Ruano S, Werneck Britto IS, Blumenfeld Y, Stoll F, Favre R, Ruano R. Prenatal Diagnosis and Perinatal Outcomes of Congenital Megalourethra: A Multicenter Cohort Study and Systematic Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2057-2064. [PMID: 26446816 DOI: 10.7863/ultra.14.12064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/21/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the prenatal findings and postnatal outcomes in fetuses with congenital megalourethra. METHODS This retrospective study reviewed our experience and the literature between 1989 and 2014. Prenatal findings were evaluated and compared with postnatal findings, including neonatal mortality and abnormal renal function (need for dialysis or renal transplantation). RESULTS Fifty fetuses with congenital megalourethra were analyzed, including 6 cases diagnosed in our centers. Most cases (n = 43 [86.0%]) were diagnosed in the second trimester. Only 1 case was diagnosed in the first trimester, whereas 6 cases (12.0%) were diagnosed in the third trimester. Thirty-five fetuses (70.0%) survived. Bilateral hydroureters were associated with perinatal death (P= .024). Among the survivors, 41.9% of the neonates had renal impairment. The following factors were associated with postnatal renal impairment: presence of severe oligohydramnios/anhydramnios (P = .033), bilateral hydronephrosis (P = .008), and earlier gestational age at delivery (P = .022). CONCLUSIONS In fetal megalourethra, bilateral hydroureters, bilateral hydronephrosis, and severe oligohydramnios/anhydramnios are associated with neonatal mortality and renal impairment.
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Affiliation(s)
- Amirhossein Moaddab
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Nicolas Sananes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Simone Hernandez-Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Ingrid Schwach Werneck Britto
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Yair Blumenfeld
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - François Stoll
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Romain Favre
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.)
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Texas USA (A.M., I.S.W.B., R.R.); Service de Gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (N.S., F.S., R.F.); Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S 1121, Biomatériaux et Bioingénierie, Strasbourg, France (N.S.); Dr Ademir C. Ruano Maternal-Fetal Clinic, São Paulo, Brazil (S.H.-R., R.R.); and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.B.).
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Migliorelli F, Martínez JM, Gómez O, Bennasar M, Crispi F, García L, Castañón M, Gratacós E. Successful Fetoscopic Surgery to Release a Complete Obstruction of the Urethral Meatus in a Case of Congenital Megalourethra. Fetal Diagn Ther 2015; 38:77-80. [DOI: 10.1159/000365988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/15/2014] [Indexed: 11/19/2022]
Abstract
We report the successful use of fetoscopy to treat a case of severe low urinary tract obstruction (LUTO) secondary to a congenital megalourethra. A second trimester male fetus presented at 21 weeks of gestation with massive dilatation of the penile urethra. In addition, bilateral hydronephrosis, an enlarged and hypertrophic bladder, with progressive oligohydramnios were found, suggesting poor prognosis. Extensive counselling was performed and, after the approval from the local ethics committee and informed consent, patients accepted fetal therapy by fetoscopy. The procedure consisted in fetoscopic identification of the tip of the penis and confirmation of the complete absence of the urethral meatus. Thereafter, under combined endoscopic and ultrasound guidance a perforation of the tip of the penis was performed with contact diode laser, until an opening into the urethra was achieved. After the operation, resolution of the cystic penile dilation, with reduction of the penile size, and normalization of the amniotic fluid volume were observed. The pregnancy continued uneventfully and a normal male infant was born at term at the local hospital. The baby was developing normally with normal renal function at 6 months of age. Our report demonstrates that fetoscopic decompression of a distal urethra obstruction can achieve neonatal survival in the rare event of congenital megalourethra.
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Abstract
This article summarizes the most recent literature regarding congenital lower urinary tract obstruction in the fetus and newborn. Lower urinary tract obstruction is a heterogeneous group of rare diagnoses that have significant potential for in utero mortality and long-term morbidity in survivors. The diagnosis and management of the most common causes are reviewed. In addition, the current state of prenatal intervention for congenital lower urinary tract obstruction is discussed.
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Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA.
| | - John W Brock
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA
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Rasouly HM, Lu W. Lower urinary tract development and disease. WILEY INTERDISCIPLINARY REVIEWS. SYSTEMS BIOLOGY AND MEDICINE 2013; 5:307-42. [PMID: 23408557 PMCID: PMC3627353 DOI: 10.1002/wsbm.1212] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Congenital anomalies of the lower urinary tract (CALUT) are a family of birth defects of the ureter, the bladder, and the urethra. CALUT includes ureteral anomaliesc such as congenital abnormalities of the ureteropelvic junction (UPJ) and ureterovesical junction (UVJ), and birth defects of the bladder and the urethra such as bladder-exstrophy-epispadias complex (BEEC), prune belly syndrome (PBS), and posterior urethral valves (PUVs). CALUT is one of the most common birth defects and is often associated with antenatal hydronephrosis, vesicoureteral reflux (VUR), urinary tract obstruction, urinary tract infections (UTI), chronic kidney disease, and renal failure in children. Here, we discuss the current genetic and molecular knowledge about lower urinary tract development and genetic basis of CALUT in both human and mouse models. We provide an overview of the developmental processes leading to the formation of the ureter, the bladder, and the urethra, and different genes and signaling pathways controlling these developmental processes. Human genetic disorders that affect the ureter, the bladder and the urethra and associated gene mutations are also presented. As we are entering the postgenomic era of personalized medicine, information in this article may provide useful interpretation for the genetic and genomic test results collected from patients with lower urinary tract birth defects. With evidence-based interpretations, clinicians may provide more effective personalized therapies to patients and genetic counseling for their families.
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Affiliation(s)
- Hila Milo Rasouly
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA
| | - Weining Lu
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA
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Yamamoto R, Ishii K, Ukita S, Hidaka N, Kobayashi K, Shimada K, Mitsuda N. Fetoscopic Diagnosis of Congenital Megalourethra at Early Second Trimester. Fetal Diagn Ther 2013; 34:63-5. [DOI: 10.1159/000348773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/05/2013] [Indexed: 11/19/2022]
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Asma B, Jumana B. Megalourethra: a case report managed with a single intrauterine bladder aspiration. Australas J Ultrasound Med 2012; 15:18-23. [PMID: 28191134 PMCID: PMC5025131 DOI: 10.1002/j.2205-0140.2012.tb00137.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Congenital megalourethra is a rare mesenchymal anomaly of the male urethra, characterised by severe dilatation of the penile urethra due to congenital absence of the corpus spongiosum and/or corpus cavernosum. Postnatal complications include voiding and erectile dysfunction as well as renal insufficiency and pulmonary hypoplasia. We present a unique case of congenital megalourethra diagnosed prenatally in the early second trimester. The parents opted to continue pregnancy and vaginal delivery of a live neonate occurred with a favourable outcome.
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Affiliation(s)
- Basha Asma
- Fetal Medicine Obstetrics and Gynecology Department The University of Jordan, Jordan University Hospital PO Box 17114 Amman 11195 Jordan
| | - Baramki Jumana
- Pediatrics Department The University of Jordan Jordan University Hospital PO Box 17114 Amman 11195 Jordan
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